Kennedy, P.T.F.; Zakaria, N.; Andreyev, H.J.N.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA108
Academic Journal
Background and Aims: Sarcoidosis is a chronic multi-system disease in which the liver can be affected with or without pulmonary involvement. The severity of liver sarcoid can vary from asymptomatic biochemical changes through to liver failure. Corticosteroids may normalise liver enzymes, but may not reverse histological changes. Guidelines how best to manage liver sarcoid are lacking. We reviewed the prevalence and extent of liver disease in a series of patients with pulmonary sarcoid between 1986-2002. Patients and Methods: 131 consecutive patients (69M:62F) who fulfilled diagnostic criteria for pulmonary sarcoid. Median age was 37 years. Hepatic involvement was defined as: serum alkaline phosphatase greater than 1.5 the upper limit of normal and GGT more than twice normal for > 3 months. Results: 41 patients (31%) had liver involvement. Liver involvement was not associated with a greater incidence of hyper-calcaemia (22% vs 21%), neurosarcoid (10% vs 8%), skin sarcoid (39% vs 27%, p > 0.5) or more severe pulmonary disease. 5 patients had abused alcohol and 1 had a high titre ANA antibody detected, but none underwent liver biopsy. Liver biopsy was performed in 2 patients with suspected liver sarcoid, 1 was diagnosed with hepatitis C. In those patients without liver involvement 79/90 (88%) required treatment for their lung disease compared with 39/41 (95%) patients with liver involvement. There was no difference between the age distribution of the 2 groups or immunosuppressants. 13 patients with liver sarcoid eventually required either azathioprine (n = 6) or methotrexate (n = 7) for their chest. Liver function subsequently normalised in 5 (methotrexate 3, azathioprine 2). Liver histology was not obtained in any of these patients. Conclusion: Liver involvement is a common finding in patients with sarcoidosis and is said to signify more severe disease. Our data do not support this but do demonstrate the need for a more complete assessment of liver disease in...


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